Smoking-attributable hospitalisation costs in Europe: an econometric analysis of the European Health Interview Survey, 2019.

Introduction: Despite significant progress achieved in the past decade, the European Union (EU) tobacco epidemic remains one of the world's most important. As the decline in smoking prevalence stagnated in the past years and little legislative progress has been made in tobacco control policies, we provide updated estimates of the healthcare costs of smoking in the EU. Methods: The study uses 2019 data from the European Health Interview Survey, covering all EU Member States except for France, Germany, Ireland and Sweden, which are excluded because of data access and data quality reasons. We apply econometric methods to examine the differential use of inpatient and daycare hospitalisation services among smokers and never smokers. Based on the model estimates, we compute the smoking-attributable costs for these hospital services across Member States. Results: We find that smoking is positively associated with inpatient and daycare hospitalisation. Across countries, smoking-related costs range from EUR 5 billion (Spain) to EUR 28 million (Latvia) for inpatient hospitalisation, and from EUR 550 million (Netherlands) to EUR 3 million (Malta and Slovenia) for daycare services. Conclusions: The results of this paper show that smoking imposes significant healthcare costs across the EU. Importantly, the total healthcare costs of smoking are likely to be significantly higher than reported in this study, which only focuses on two types of healthcare services. These updated estimates underscore the need to reinvigorate tobacco control policies at national and EU level to reduce the health and economic burden of smoking and protect the health systems resources.